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Decision-making processes for essential packages of health services: experience from six countries
  1. Rob Baltussen1,
  2. Omar Mwalim2,
  3. Karl Blanchet3,
  4. Manuel Carballo4,
  5. Getachew Teshome Eregata5,
  6. Alemayehu Hailu2,6,
  7. Maryam Huda7,
  8. Mohamed Jama8,
  9. Kjell Arne Johansson5,
  10. Teri Reynolds9,
  11. Wajeeha Raza10,
  12. Jacque Mallender11,
  13. Reza Majdzadeh12
  1. 1 Department of Health Evidence, Radboudumc, Nijmegen, The Netherlands
  2. 2 Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
  3. 3 Global Health Development, University of Geneva Faculty of Medicine, Geneve, Switzerland
  4. 4 International Centre for Migration and Health, Geneva, Switzerland
  5. 5 Department of Global Public Health and Primary care, University of Bergen Faculty of Medicine and Dentistry, Bergen, Norway
  6. 6 Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
  7. 7 Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
  8. 8 Federal Government of Somalia, Mogadishu, Somalia
  9. 9 Department of Integrated Health Services, World Health Organization, Geneva, Switzerland
  10. 10 Centre for Health Economics, University of York, York, UK
  11. 11 EconomicsbyDesign, London, UK
  12. 12 School of Health and Social Care, University of Essex, Colchester, UK
  1. Correspondence to Professor Rob Baltussen; rob.baltussen{at}radboudumc.nl

Abstract

Many countries around the world strive for universal health coverage, and an essential packages of health services (EPHS) is a central policy instrument for countries to achieve this. It defines the coverage of services that are made available, as well as the proportion of the costs that are covered from different financial schemes and who can receive these services. This paper reports on the development of an analytical framework on the decision-making process of EPHS revision, and the review of practices of six countries (Afghanistan, Ethiopia, Pakistan, Somalia, Sudan and Zanzibar-Tanzania).

The analytical framework distinguishes the practical organisation, fairness and institutionalisation of decision-making processes. The review shows that countries: (1) largely follow a similar practical stepwise process but differ in their implementation of some steps, such as the choice of decision criteria; (2) promote fairness in their EPHS process by involving a range of stakeholders, which in the case of Zanzibar included patients and community members; (3) are transparent in terms of at least some of the steps of their decision-making process and (4) in terms of institutionalisation, express a high degree of political will for ongoing EPHS revision with almost all countries having a designated governing institute for EPHS revision.

We advise countries to organise meaningful stakeholder involvement and foster the transparency of the decision-making process, as these are key to fairness in decision-making. We also recommend countries to take steps towards the institutionalisation of their EPHS revision process.

  • Public Health

Data availability statement

The data supporting the findings of this study are available upon request to the corresponding author.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2022-010704

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    Data availability statement

    The data supporting the findings of this study are available upon request to the corresponding author.

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    Footnotes

    • Handling editor Seye Abimbola

    • Twitter @BlanchetKarl, @GetachewTesho14, @KA_Johansson

    • Contributors All authors were involved in the study development and data collection/interpretation. RB, OM and RM analysed the data and wrote the first version. All authors contributed to writing the final version. RB is responsible for the overall content as guarantor.

    • Funding Funding was made available through a grant from the Bill & Melinda Gates Foundation, number OPP1201812

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.